What is Pathological Demand Avoidance

While all autism profiles involve challenges with social communication, sensory processing, and emotional regulation, PDA presents in unique ways:

• Demand Avoidance: Unlike other autism profiles where sensory sensitivities or communication difficulties may be more prominent, PDA is marked by a significant and consistent avoidance of demands.
• Anxiety-Driven Control: Demand avoidance in PDA is often linked to anxiety rather than a desire for non-compliance.
• Social Interaction Differences: Children with PDA may appear more socially fluent than those with classic autism traits, sometimes engaging in role-playing or mimicking social behaviour while still struggling with genuine social connections.
• Surface-Level Social Skills: Many children with PDA may demonstrate superficial social charm but can struggle with deeper emotional understanding.

Recognising these differences is essential, as children with PDA often require approaches that focus on reducing anxiety rather than increasing structure or discipline.

• Extreme Avoidance of Demands: Children with PDA may resist everyday tasks such as getting dressed, brushing their teeth, or completing schoolwork.
• Avoidance Strategies: They may use tactics like distraction, role-playing, or humour to avoid demands.
• Role-Playing as a Coping Mechanism: Some children engage in fantasy play, such as pretending to be a different character, to distance themselves from the task being asked of them.
• Refusal or Shutdowns: When feeling overwhelmed, a child with PDA may either refuse tasks outright or enter a shutdown state, becoming unresponsive.

• High Anxiety Levels: Anxiety often drives demand avoidance and can manifest as controlling behaviours or emotional outbursts.
• Mood Swings: Children with PDA may shift from calm to distressed rapidly, especially when faced with unexpected demands.
• Surface-Level Social Skills: They may demonstrate social interaction skills that seem typical but struggle with deeper connections and emotional reciprocity.
• Difficulty with Authority Figures: Children with PDA may resist instructions, even from familiar caregivers or teachers, as a way to manage their anxiety.

• Sensory Sensitivities: Many children with PDA experience sensory sensitivities similar to other autism profiles, such as being overwhelmed by loud noises, bright lights, or certain textures.
• Need for Control: A strong desire for control can lead to micromanaging situations or making their own rules during play.
• Rigid Thinking: Children with PDA may struggle with flexible thinking, preferring predictable routines or specific ways of doing things.

The diagnostic process for PDA typically involves:

• Developmental History Review: Professionals may gather detailed information about the child’s developmental milestones and early behaviours.
• Behavioural Observations: Evaluations often focus on how the child responds to everyday demands and their coping mechanisms.
• Parental Input: Parents’ insights into their child’s reactions to demands and anxiety triggers play a key role in the assessment process.
• Professional Expertise: Assessments are often conducted by developmental paediatricians, psychologists, or occupational therapists experienced with PDA traits.

It’s important for assessments to consider the full range of the child’s behaviours, including both demand avoidance and moments when the child feels more relaxed and capable.

Parents may consider seeking a professional evaluation if they notice:

• Persistent avoidance of everyday tasks despite various approaches.
• Consistent anxiety-driven behaviour when faced with routine demands.
• Emotional outbursts or shutdowns linked specifically to feeling controlled.
• Significant difficulty coping with authority figures or structured environments.

Early identification can lead to better access to personalised support strategies, helping families navigate challenges more effectively.